scholarly journals Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alessandra Vergori ◽  
◽  
Patrizia Lorenzini ◽  
Alessandro Cozzi-Lepri ◽  
Davide Roberto Donno ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Respiratory Function ◽  
Low Molecular Weight Heparin ◽  
Orotracheal Intubation ◽  
P Value ◽  
Low Molecular Weight ◽  
Therapeutic Dosage ◽  
Clinical Progression ◽  
Interaction Test

AbstractProphylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneumonia. Patients admitted to a COVID-hospital in Rome with SARS-CoV-2 infection and mild/moderate pneumonia were retrospectively evaluated. The primary endpoint was the time from hospital admission to orotracheal intubation/death (OTI/death). A total of 449 patients were included: 39% female, median age 63 (IQR, 50–77) years. The estimated probability of OTI/death for patients receiving pLMWH was: 9.5% (95% CI 3.2–26.4) by day 20 in those not receiving pLMWH vs. 10.4% (6.7–15.9) in those exposed to pLMWH; p-value = 0.144. This risk associated with the use of pLMWH appeared to vary by PaO2/FiO2 ratio: aHR 1.40 (95% CI 0.51–3.79) for patients with an admission PaO2/FiO2 ≤ 300 mmHg and 0.27 (0.03–2.18) for those with PaO2/FiO2 > 300 mmHg; p-value at interaction test 0.16. pLMWH does not seem to reduce the risk of OTI/death mild/moderate COVID-19 pneumonia, especially when respiratory function had already significantly deteriorated. Data from clinical trials comparing the effect of prophylactic vs. therapeutic dosage of LMWH at various stages of COVID-19 disease are needed.

scholarly journals Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia

2020 ◽  
Author(s):  
Alessandra Vergori ◽  
Patrizia Lorenzini ◽  
Alessandro Cozzi Lepri ◽  
Davide Roberto Donno ◽  
Gina Gualano ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Respiratory Function ◽  
Low Molecular Weight Heparin ◽  
Orotracheal Intubation ◽  
P Value ◽  
Low Molecular Weight ◽  
Therapeutic Dosage ◽  
Clinical Progression ◽  
Interaction Test

Abstract Prophylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneumonia.Patients admitted to a COVID-hospital in Rome with SARS-CoV-2 infection and mild/moderate pneumonia were retrospectively evaluated. The primary endpoint was the time from hospital admission to orotracheal intubation/death (OTI/death). A total of 449 patients were included: 39% female, median age 63 (IQR, 50-77) years. The estimated probability of OTI/death for patients receiving pLMWH was: 9.5% (95%CI 3.2-26.4) by day 20 in those not receiving pLMWH vs. 10.4% (6.7-15.9) in those exposed to pLMWH;p-value=0.144. This risk associated with the use of pLMWH appeared to vary by PaO2/FiO2 ratio: aHR 1.40 (95%CI 0.51-3.79) for patients with an admission PaO2/FiO2 < 300 mmHg and 0.27 (0.03-2.18) for those with PaO2/FiO2 >300 mmHg;p-value at interaction test 0.16. pLMWH does not seem to reduce the risk of OTI/death mild/moderate COVID-19 pneumonia, especially when respiratory function had already significantly deteriorated. Data from clinical trials comparing the effect of prophylactic vs. therapeutic dosage of LMWH at various stages of COVID-19 disease are needed.

Rezidivierende isolierte Unterschenkelmuskelvenenthrombose bei Soleusvenenaneurysma

VASA ◽  
2002 ◽  
Vol 31 (4) ◽  
pp. 277-279 ◽  
Author(s):  
Schwarz ◽  
Zimmermann ◽  
Hänig ◽  
Schröder ◽  
Schellong
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Rare Case ◽  
Calf Muscle ◽  
Venous Aneurysm ◽  
Low Molecular Weight ◽  
Therapeutic Dosage ◽  
Follow Up Study ◽  
Short Course

A rare case of venous aneurysm involving the soleal muscle vein in an 18-year-old woman is presented. The patient showed three episodes of ultrasonographically proven calf muscle thrombosis within 2 years. After a short course of low-molecular-weight heparin at a therapeutic dosage, complete thrombus recanalization was achieved. To prevent further thrombotic episodes, surgery including ligation and resection of the aneurysm was performed. At the 3-month follow-up study the patient had completely recovered.

Low molecular weight heparin and cancer survival: clinical trials and experimental mechanisms

2016 ◽  
Vol 142 (8) ◽  
pp. 1807-1816 ◽  
Author(s):  
Ning Zhang ◽  
Weihua Lou ◽  
Fang Ji ◽  
Lihua Qiu ◽  
Benjamin K. Tsang ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Low Molecular Weight Heparin ◽  
Cancer Survival ◽  
Low Molecular Weight

Thrombocytopenia Is More Common and Nadir Occurs Earlier with Unfractionated Heparin Than with Low Molecular Weight Heparin - Results from the Prospective Catch Registry.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2197-2197
Author(s):  
Stephan Moll ◽  
Charles S. Abrams ◽  
Lawrence Rice ◽  
Richard C. Becker ◽  
Peter B. Berger ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Platelet Count ◽  
Unfractionated Heparin ◽  
Low Molecular Weight Heparin ◽  
Heparin Therapy ◽  
P Value ◽  
Low Molecular Weight ◽  
Life Threatening ◽  
The Difference ◽  
Time To Onset

Abstract Background : Thrombocytopenia in the patient on heparin can have various etiologies, including benign reversible causes and serious, potentially life-threatening ones, such as heparin induced thrombocytopenia (HIT). Knowledge about the prevalence of and timecourse of thrombocytopenia in heparin-treated patients may be helpful to develop systems of alerting clinicians to possible HIT and determining how frequently to check blood counts to detect thrombocytopenia that may be heralding HIT. Methods : The CATCH registry is a prospective registry of inpatients enrolled between March 2003 and April 2004 at over 50 US hospitals in 3 strata: [1] receiving > 96 hours of unfractionated heparin (UFH) or low molecular weight heparin (LMWH), [2] developing thrombocytopenia (platelets >50% reduction from baseline or <150,000/mm3) in the cardiac care unit and [3] patients on whom HIT tests were ordered. Here we present the data of the prolonged heparin stratum. Results : 1,121 and 861 patients received UFH and LMWH, respectively, for > 96 hours. A platelet count decrease of > 50 % from baseline was seen more frequently in patients on UFH than in patients on LMWH (10.7% and 7.9 %, respectively; p = 0.03). The parameters that predicted development of thrombocytopenia in the UHF group were length of heparin therapy, body mass index, and admission to a cardiac service; the only parameter predicting thrombocytopenia in the LMWH group was length of LMWH treatment. Of the patients with decreased platelet count by > 50 % from baseline (for UFH n = 120; for LMWH n = 68), this drop occurred in the UFH group at a median of 3.0 days after initiation of heparin and at a median of 4.0 days in the LMWH group. The difference in timing between the 2 groups was not statistically significant (p = 0.205). The platelet nadir was reached after a median /mean of 4.0 / 7.4 days in the UFH group, and 8.0 / 11.4 days in the LMWH group. This was statistically significantly different between the 2 groups (p-value = 0.0025). Conclusions : A platelet count decrease of > 50 % from baseline occurs frequently in inpatients treated with prolonged heparin. It occurs slightly more frequently on UFH than on LMWH. The median time to onset of thrombocytopenia (> 50 % decrease from baseline) occurs early, at 3–4 days. Daily platelet count checks in the first few days of heparin therapy may be helpful to rapidly discover thrombocytopenia that may then prompt HIT testing.

Correlation between Antifactor Xa Activity and Thrombin Generation Time, Platelet Contractile Force and Clot Elastic Modulus Following Enoxaparin Exposure in Patients with and without Renal Dysfunction.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4144-4144
Author(s):  
Donald F. Brophy ◽  
Erika J. Martin ◽  
Todd W.B. Gehr ◽  
Al M. Best ◽  
Marcus E. Carr
Keyword(s):  
Molecular Weight ◽  
Renal Dysfunction ◽  
Generation Time ◽  
Low Molecular Weight Heparin ◽  
Thrombin Generation ◽  
Contractile Force ◽  
P Value ◽  
Low Molecular Weight ◽  
Antifactor Xa ◽  
Correlation Parameters

Abstract Patients with renal dysfunction that receive hemodialysis (HD) are highly sensitive to low molecular weight heparin (LMWH) drugs such as Enoxaparin. There have been numerous reports of hemorrhagic effects with these drugs in this population. Although current guidelines recommend judicious monitoring of antifactor Xa activity in HD patients to prevent adverse events, this parameter is poorly correlated to efficacy and toxicity. Newer, more specific parameters such as thrombin generation time (TGT), platelet contractile force (PCF) and clot elastic modulus (CEM) may play a role in monitoring LMWH drugs in high-risk populations such as those with renal dysfunction. To determine the utility of monitoring TGT, PCF and CEM for this purpose, we conducted a prospective clinical trial in 8 non-thrombosed HD and 8 control subjects. All subjects received escalating doses of Enoxaparin 0.25, 0.50 and 1.0 mg/kg subcutaneously during this study. Blood samples were obtained four hours post-dose to capture the peak effect of Enoxaparin on antifactor Xa activity, TGT, PCF and CEM. Pearson’s correlation was used to determine the relationships between antifactor Xa activity and TGT, PCF and CEM at each dose, respectively. Repeated measures analysis of covariance was used to assess for intergroup differences in the slopes of each regression line using the group status and antifactor Xa concentration as the covariates. The correlation coefficient (r), coefficient of determination (r2) and p-value for each parameter in each group are listed in the Tables. The figure illustrates the relationship between antifactor Xa and TGT in both controls and ESRD patients. These findings suggest that TGT, PCF and CEM are highly correlated to antifactor Xa activity in patients with and without renal dysfunction. There were no differences in the slopes of the regression lines between groups. Further studies are needed to determine if TGT, PCF and CEM provide more useful clinical information regarding the level of anticoagulation in high-risk patients receiving low-molecular weight heparin therapy. TGT vs. Antifactor Xa Activity TGT vs. Antifactor Xa Activity Correlation Parameters for Antifactor Xa and TGT, PCF and CEM for Control Subjects Model r r2 P-value Antifactor Xa vs. TGT 0.88 0.77 0.001 Antifactor Xa vs.PCF 0.85 0.73 0.0003 Antifactor Xa vs. CEM 0.80 0.63 0.02 Correlation Parameters for Antifactor Xa and TGT, PCF and CEM for HD subjects Model r r2 P-value Antifactor Xa vs. TGT 0.91 0.82 0.0002 Antifactor Xa vs. PCF 0.90 0.80 0.0004 Antifactor Xa vs. CEM 0.90 0.80 0.0005

scholarly journals COVID-19 PNEUMONIA: THE POINT OF VIEW OF VASCULAR SPECIALIST

2020 ◽  
pp. 21-27
Author(s):  
Luca Costanzo ◽  
Simona Antonina Grasso ◽  
Francesco Paolo Palumbo ◽  
Giorgio Ardita ◽  
Luigi Di Pino ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Antiviral Effect ◽  
Protein Product ◽  
Point Of View ◽  
Low Molecular Weight ◽  
Potential Mechanism ◽  
Therapeutic Dosage ◽  
Prognostic Features ◽  
D Dimer

The development of coagulopathy is emerging as one of the most significant poor prognostic features in COVID-19 pneumopathy. Thromboembolic manifestations such as pulmonary embolism and disseminated intravascular coagulation (DIC) have been reported and resulted in poor prognosis for the patient. Starting from the evidence in the literature, the purpose of this paper is to analyze potential mechanism involved in coagulation impairment following COVID-19 infection and identify possible vascular therapeutic strategies. D-dimer, a protein product of fibrin degradation, has been found elevated in the most severe cases and correlated to mortality. Potentially involved factors in the impairment of coagulation caused by viral infection include the dysregulated inflammatory response, platelet and endothelial dysfunction with impaired fibrinolysis. Heparin is an anticoagulant molecule that also showed anti-inflammatory properties and a potential antiviral effect. A favorable outcome was highlighted with the use of LMWH in severe patients with COVID-19 who meet the SIC criteria (sepsis-induced coagulopathy) or with markedly high D-dimer. The use of low molecular weight heparin could prevent thromboembolic complications in COVID-19 pneumopathy. However, the correct timing of prophylaxis according to the stage of COVID-19 disease and the appropriate therapeutic dosage to use in severe cases need further researches. Keywords: COVID-19, pneumonia, thrombosis, coagulopathy, D-dimer, low molecular weight heparin. Одним из наиболее неблагоприятных прогностических признаков пневмопатии при COVID-19 является развитие коагулопатии. У пациентов с COVID-19 наблюдались признаки тромбоэмболии, например тромбоэмболия легочной артерии и ДВС-синдром, что негативно сказывалось на здоровье пациента. Целью исследования является анализ потенциального механизма нарушения свертывания крови у пациентов, перенесших COVID-19, и определение возможных терапевтических стратегий. Было обнаружено, что у пациентов с тяжелой формой заболевания уровень D-димера, белкового продукта распада фибрина, повышен и напрямую взаимосвязан со смертностью. К факторам, влияющим на нарушение коагуляции, вызванной вирусной инфекцией, относятся неуправляемый воспалительный процесс, тромбоцитарная и эндотелиальная дисфункция с нарушением фибринолиза. Гепарин, являясь прямым антикоагулянтом, также обладает противовоспалительными свойствами и выраженным противовирусным эффектом. Благоприятный исход наблюдался при использовании низкомолекулярного гепарина у тяжелых пациентов с COVID-19 с коагулопатией, вызванной сепсисом, или высоким уровнем D-димера. Использование низкомолекулярного гепарина может предотвратить тромбоэмболические осложнения пневмопатии у пациентов с COVID-19. Тем не менее точное время профилактики в зависимости от стадии заболевания COVID-19 и соответствующая терапевтическая дозировка, которая может быть использована в тяжелых случаях, требуют дальнейших исследований. Ключевые слова: COVID-19, пневмония, тромбоз, коагулопатия, D-димер, низкомолекулярный гепарин.

Dalteparin: A Low-Molecular-Weight Heparin

1997 ◽  
Vol 31 (2) ◽  
pp. 192-203 ◽  
Author(s):  
Patricia A Howard
Keyword(s):  
Clinical Trial ◽  
Molecular Weight ◽  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Clinical Trial Data ◽  
Trial Data ◽  
Fixed Dose ◽  
Low Molecular Weight ◽  
Review Articles

Objective To discuss the chemistry, pharmacology, and pharmacokinetics of dalteparin, a low-molecular-weight heparin (LMWH), and to review the comparative clinical trial data evaluating the efficacy and safety of dalteparin and unfractionated heparin (UH) for the prophylaxis and treatment of venous thromboembolism. Data Sources A MEDLINE search identified pertinent English-language publications on dalteparin and venous thromboembolism. Key search terms were dalteparin, Fragmin, LMWH, and venous thromboembolism. The search was supplemented by review articles, articles obtained from the bibliographies of the review articles, and the dalteparin approval database. Study Selection The most pertinent studies describing the pharmacology and pharmacokinetics of dalteparin in humans were selected; all abstracts and clinical trials evaluating the use of dalteparin for antithrombotic therapy were reviewed. Review articles by authors of international reputation were selected. Data Extraction Pertinent information from the review articles on the pharmacology of LMWHs and UH was summarized. Clinical trial data were extracted for study design, patient demographics, therapeutic regimens, methods of evaluation, and outcomes. Data Synthesis Dalteparin is an LMWH indicated for patients undergoing abdominal surgery who are considered to be at risk for deep-vein thrombosis (DVT), which may lead to pulmonary embolism (PE). In this population, numerous clinical trials have demonstrated comparable efficacy between dalteparin and fixed-dose UH for DVT prophylaxis. Dalteparin has a predictable dose response and can be administered as a standard single daily subcutaneous dose for all patients. In therapeutic doses, dalteparin does not alter coagulation tests and therefore does not require routine laboratory monitoring, in contrast with adjusted-dose UH. Bleeding risks with dalteparin are comparable with and possibly less than those associated with UH. Preliminary studies suggest that dalteparin may be effective for other indications, including DVT prophylaxis for hip replacement surgery and the treatment of DVT and PE. Comparative cost-effectiveness data are not yet available. Conclusions Dalteparin is the second LMWH to receive approval by the Food and Drug Administration. Dalteparin is indicated for prophylaxis against DVT in patients undergoing abdominal surgery. Clinical studies have shown that single daily doses of dalteparin provide a safe and effective alternative to fixed-dose UH therapy. Additional studies are needed to determine the cost-effectiveness of dalteparin compared with UH and other LMWHs.

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